疝，寒实之病也，其或挟热者，即系证之变。治之之法，主在温散，然亦有姑从于权而必须调停者。仲景
之例，固不外于温，乌头二方及当归生姜羊肉汤，俱其正治，而有缓急之别。如柴胡桂枝汤，特其权法也。至
金元以降，则往往执其变而遗其常，泥其权而失其正，论说颇涉纷拿。此编于异同之言，或有不得芟除者，要
在读者弃瑕取瑜尔。
名义 疝，腹痛也。（《说文》）
心痛曰疝，疝，诜也，气诜诜然上而痛也。阴肿曰 ，气下 也；又曰疝，亦言诜也，诜诜引小腹急痛也。
（《释名》）
疝，腹中气疾，上下引也。（《急就章》颜师古注）
病因阴寒 诸疝者，阴气积于内，复为寒气所加，使荣卫不调，血气虚弱，故风冷入其腹内而成疝也。
寒疝者，阴气积于内则卫气不行，卫气不行则寒气盛也。故令恶寒不欲食，手足厥冷，绕脐痛，自汗出，遇寒
即发，故云寒疝也。疝者痛也（此句据《外台》补），此由阴气积于内，寒气结搏而不散，腑脏虚弱，故风邪
冷气与正气相击，则腹痛里急，故云寒疝腹痛也。夫寒疝心痛，阴气积结所生也。阴气不散则寒气盛，寒气盛
则痛上下无常处，冷气上冲于心，故令心痛也。（《病源论》）
疝者，寒气结积之所为也。（《素问次注》）
病因肾虚 肾主纳气，人之气海系焉。肾虚而为风寒所乘，为暑湿所袭，为喜怒忧恐所伤，而水结不
散，又与气搏，是以群邪聚于其中，曰疝，曰奔豚，曰小肠气，曰膀胱气，皆是物也。（《直指》）（宜参次
款《医学管见》文。）
病属肝兼湿热说并斥非 诸疝皆归肝经，其奈庸流归之小肠脬囊。夫膀胱水府，专司渗泄，小肠水道，
专主通流，肾为少阴，总统二水。人之小溲，自胃入小肠，渗入膀胱。膀胱者，脬囊也，气化则水出茎端，此常
道也。及其为疝，乃属足厥阴肝经，盖环阴器而上入小腹者，足厥阴肝经也。夫肝肾皆属于下，与冲任督相附。
然《灵枢经》言足厥阴肝经病，则有遗溺癃闭狐疝，主肾与膀胱小肠三经，则不言疝，是受疝之处，乃肝之部
分也。（此下原更引《素·灵》及《铜人》论疝本肝经之理，文繁不录。）且夫遗溺闭癃，阴痿脬痹，精滑
白淫，皆男子之疝也，不可妄归之肾冷。血涸不月，月罢腰膝上热，足 嗌干癃闭，少腹有块，或定或移，前
阴突出，后阴痔核，皆女子之疝也，但女子不谓之疝而谓之瘕。若年少而得之，不计男子妇人皆无子，故隐蔽
委曲之事，了不干脬肾小肠之事，乃足厥阴肝经之职也。奈俗方止言脬肾小肠，殊不言肝木一句，惑人甚矣。
（《儒门事亲》）
疝病未有不本于肝者。盖任为阴脉之海，其脉同足厥阴并行腹里，而五脏之疝，其脉曰搏急曰滑。夫搏
急是肝脉，滑则为病风，风气通于肝，故任脉诸脏虽皆有疝，莫不连合肝经，所谓有形如瓜，有声如蛙，或上
于腹，或下于囊者，方可谓之疝病；其不与肝相干者，则不得谓之疝矣。至论疝病之因，有主寒者，有主湿热
者，有火从寒化者，要之疝病不离寒湿热三者之邪。寒则急，热则纵，湿则肿，而尤必以
寒气为之主。其有热者，寒邪郁热于内，非热能病疝，亦非热能变寒也，故曰热为寒郁则可，热从寒化则不可。
（《金匮翼》）（按∶说系错综子和及《格致余论》文，稍加删润。又《医统》曰∶大抵不过寒湿热之邪气，
分三因尽之矣。其说不免粗略，仍不录。）
医经论疝，皆以为寒湿之证；丹溪独谓由内有郁热所致，内无郁热，外虽感寒湿之气，亦不病疝。其论甚
辩，然实非也。盖此证多由于肾之元精内虚所致。元精内虚，寒湿之气乘虚而入，有所结滞，阻碍真气，故相
攻而作痛；元精内实，则虽有寒湿之气，不能侵入，故不作痛，此亦疝病之标本也，郁热之有无何与焉，丹溪
之说误矣。世医皆以疝为肾病，或以为小肠气，则心之府也。张子和独据《灵枢经》，谓疝为肝经病，无关于
肾。予复谓疝病由于肾之内虚，无乃蹈世医之陋乎。曰∶子和之论深矣，然世医之论，则亦未为失也。盖手厥
阴命门与足厥阴肝经同主元精，而发用在肾之后窍，故古经谓右肾为命门，实为肾之后窍，而非右肾也。多欲
之人，肾之施泄无度，故元精内虚，邪乘虚而入，乃发为疝病，其证少腹与睾丸诸筋相引而痛。子和以元精属
肝，诸筋亦属肝，故谓疝为肝经之病；而不知元精之虚，由肾之施泄无度所致，筋虽属肝，而肾实为宗筋之会，
况少腹在下，亦属肾部。医家相传，谓疝为肾病，盖自有所见，而未可非也。至名为小肠气，则亦以其在下部
故云。治疝之药，则须用“热因寒用”之法，更加解结之药可也。（《医学管见》）
疝气之病，有寒证，亦有热证。然必因先受寒湿，或犯生冷，以致邪聚阴分，此其肇端之始，则未有不因
寒湿而致然者。及其病郁既久，则郁而成热者有之；或以阳脏之人，
火因邪聚，而湿热相资者亦有之。故在《内经》言疝，则寒热皆有所论。如曰病在少腹，腹痛不得大小便，病
名曰疝，得之寒。曰阴亦盛而脉胀不通，故曰 癃疝也。曰肝痹得之寒湿，与疝同法。曰太阳太阴阳明之胜复，
皆有疝气。是皆言疝之寒也。又如曰脾风传肾，名曰疝瘕，少腹冤热而痛，出白，一名曰蛊。曰足厥阴之筋病，
阴器不用，伤于寒则阴缩入，伤于热则纵挺不收。是皆言疝之热也。此《内经》之言寒言热，未尝偏废者如此。
观丹溪曰∶自素问而下，皆以为寒。盖寒主收引，经络得寒，则引而不行，所以作痛者。然亦有踢冰涉水，终
身不病此者，无热在内故也。大抵此证，始于湿热在经，郁而至久，又得寒气外束，不得疏散，所以作痛。若
只作寒论，恐未为备。（按∶此出《格致余论》）此丹溪之论如此，故其治多从火，而倍用山栀、黄柏之属，
余则不能无言也。观《内经》之言疝者如前，原非只作寒论，第言寒者较多于热，亦是疝家之正理，不可易也。
矧疝以寒邪入经，所以为痛，及其久也，方为郁热。使其始不受寒，何由致疝，此寒为本而热为标也。若谓始
于湿热在经，又得邪气外束，所以作痛，则反以热为本而寒为标矣，岂其然乎。至若踢冰涉水，终身不病者，
此虽有贵贱之分，久暂之异，然必以阳气内实而寒不能犯者有之。若谓无热在内，故寒自不入，又岂其然乎。
此致病之因，有不得不辨也。是以《内经》之论，凡至切至当者，胡可弗遵；后世之谈，其多凿多偏者，安庸
尽信。（《景岳》）
所因不一 凡治疝之法，当察所由。此虽以受寒受湿，因而成疝；然或以色欲，或以劳损，或以郁怒，
或以饮食酒湿之后，不知戒慎，致受寒邪，则以阴求阴，流结于冲任血气之海而下归阴分，遂成诸疝。故其为
病，则有遇寒而发
者；有郁久成热，遇热而发者；有郁则气逆，遇郁怒而发者；有湿因寒滞，遇湿而发者；有疲极则伤筋，遇劳苦
而发者；有虚邪在少阴厥阴，遇色欲而发者；有饮食之湿在阳明太阴，遇酒酪而发者。至其久也，则正气陷而
不举，邪气留而不去，而为 为疝，难于愈矣。故治此者，必当因其所因，辨而治之，则无不随手可愈。若茫然
混然，徒执一偏之见而至老不寤者，即与之谈，终无益也。（《景岳》）
脉候 寸口之中云云，内结者，病疝瘕也。脉细小紧急，病速进，在中，寒为疝瘕积聚，腹中刺痛。
（《脉经》）
尺寸脉俱牢（一作芤），直上直下，此为冲脉，胸中有寒疝也。脉来中央坚实，径至关者，冲脉也，动
苦少腹痛，上抢心，有瘕疝，绝孕，遗矢溺，胁支满烦也。（同上）
诊妇人疝瘕积聚，脉弦急者生，虚弱小者死。（同上）
脉沉细而滑者，曰疝瘕。紧急而滑者，曰疝瘕。（《病源论》）
疝气者。气聚而大。外仍敛束。故脉则见弦急。而症则多胀痛也。弦敛急直。气不鼓畅。主诸疝胀。疝则未
有不痛胀者。若弦急而牢。见积聚之有根。亦征元本之壮实。脉证两宜。故曰生。若但急而弱。急则邪盛。弱
则正衰。更非积聚在里者之所宜。故曰死。（《续焰》）（按∶丹溪有挟虚者。其脉沉紧豁大之说。见于后。）
证治诸说 疝者，痛也。或少腹痛，不得大小便；或手足厥冷，绕脐痛，自汗出；或冷气逆上抢心腹，
令心痛；或里急而腹痛，此诸候非一，故云诸疝也。（《病源论》）
疝之为病，随脏气虚实，感伤外邪，寒泣风散，暑郁湿着，绞刺击搏，无有定处，仓卒之际，痛不堪忍。
世人称为横弦竖弦，膀胱小肠气，贼风入腹等，名义不同，证状则
一。寒则温之，风则散之，暑则利之，湿则燥之，各有成法。（《三因》）
其候不特外肾小腹作痛，或攻刺于腰胁，或游走于背膂，或冷气抢心，心下痛满，或手足厥冷，痛绕脐旁，
或胁之左右如杯，或脐之上下如臂，或腹中累累如桃李，或胃脘间覆大如盘，有壮热恶寒者，有洒淅寒热者，
有不得大小便者，有里急而下泄者，有自汗出者，有不欲食者，其于阴间，则卵有大小伸缩而上下不常，囊有肿
胀急痛而发歇无定，挟冷触怒，则块物逼上囊根或攻腹胁，时和心平，则块物自循 系归入囊中。凡此皆谓之
肾气，治法纲领，风则散之，寒则温之，暑则解其热，湿则渗其水，七情所发，调其心气，水与气搏，行其小便，
其间以主治肾气之剂参之，固定则也。然总治之法，大要以流行疏利为先，毋曰肾虚得病，不敢疏泄，盖肾为
邪气所干，若非逐去，病何由愈（按∶此说本于《本事》，彼说见后）。傥或姑息畏虚，妄以刚剂兜住，使大
小腑秘而不通，邪气入腹冲心，危殆必矣。虽然，肾气发作，固以肾虚得之；然虚中有冷，虚中有热，又有冷
热不调，尤当详审。冷者，胁边及外肾清冷而小便多，遇寒即发是也。热者，内挟暑气，或积酒毒，或服暖药
于前，外肾与小肠俱热，肛门间粪后亦热，小便数而涩，遇热则甚是也。冷热不调者，小腹外肾乍冷乍热，大
便小便或秘或利。用药温凉，当随证而权度之，但所谓流行疏导，常常运斡于其中矣。其大小便流利之后，或
更有牵刺引疼，或微气游注于肌肤之间，此则肾虚血虚，气不还元，当加润养，人参、当归、川芎、芍药、桑
螵蛸、葫芦巴辈，又不可无。（《直指》）
疝气之甚者，睾丸连小腹急痛也。有痛在睾丸者，有痛在五枢穴边者，皆足厥阴之经也。或有形，或无形，或有
声，或无声，有形如瓜，有声如蛙（云云）。又有挟虚而发者，当以参、术为用，而以疏导药佐之，诊其脉有
甚沉紧而大豁无力者是也，其痛亦轻，惟觉重坠牵引耳。（《格致余论》）（按∶《纲目》曰∶盖疏导药，即
桃仁、山楂、枳实、栀仁、茱萸、川楝、玄胡索、丁香、木香之类，以佐参、术之类是也。又《汇补》甚沉紧
作不甚沉紧，参、术下补桂、附，且曰∶若泛用克伐，必变攻胃冲心而死。）
诸疝痛处，用手按之大痛者，为实也；按之不定者，属虚。（《丹溪》）（此凑合《纲目》及《心法》）
气因寒聚为疝，血因寒聚为瘕，即是疝气，今谓之横弦竖弦，绕脐走注，小腹 痛，宜蟠葱散，吞下茱萸
内消丸，或盐酒调异功散。不问何证，皆可用生料五苓散，加炒 香半钱或一钱。服药未效，大痛攻刺不已，
阴缩手足厥冷，宜香附子，仍炒盐乘热用绢裹，熨脐下。若大小腑不甚通者，五苓散加桂，下青木香丸。初发
，或头疼身热，或憎寒壮热，并宜参苏饮加木香。有逆上攻心，下不觉痛，而见心疼者，宜以生韭捣取自然汁，
和五苓散为丸， 香汤下。（《要诀》）（按∶《易简方》曰∶疝气初发，必先憎寒壮热，甚者呕逆恶心，每用
参苏饮云云。此戴氏所本。）
初发，或头疼身热，或憎寒壮热，重者逆上攻心，疼痛呕吐，手足冷，脉沉急。必先以祛散寒邪，兼佐疏
肝消疝之剂，使病气伏而病易退也。若按以子和所立攻下之法，只恐病未除而先虚元气，其不为倾败者鲜矣，
学人宜致思焉。（《统旨》）
寒疝最能作痛，多因触冒寒邪，或犯生冷所致，凡喜暖畏寒，脉弦细，鼻尖手足多冷，大小便无热之类
皆是也。热疝大能作痛，凡火邪聚于阴分而为痛者，必有热证热脉，或
大便秘结，或小水热闭不通，或为胀为满而烦热喜冷者是也。又有肾本不虚，而肝经湿热火旺，茎中作痛，筋
急缩，或痛或痒或肿，或挺纵不收，白物如精，随溺而下者，此筋疝也，宜龙胆泻旺汤主之。湿疝多为重坠胀
满，然亦有痛者，宜以前寒热证参而治之。有不痛而久坠不愈者，是即 疝之属，单宜治湿理气。疝病遇酒而
发者，多因湿热，当先去其湿。血结少腹间者，是为血疝，但察其非气非食，小腹硬而有形，大便秘结而黑，
小水利者，必血积、血疝之属。疝遇色欲而发者，是必阴虚之属。疝久者必多虚证，或以元气本虚而偶患者亦
Shan (Hernia/Colic), is a disease of cold excess. In some cases, it may be complicated by heat, which represents a variation in the syndrome. The primary treatment method lies in warming and dispersing, although there are instances where temporary adaptive measures must be employed to harmonize the condition. Zhang Zhongjing's examples certainly do not deviate from warming; the two formulas involving Aconitum (Wutou) and the Danggui Shengjiang Yangrou Tang (Angelica Sinensis, Ginger, and Lamb Mutton Decoction) are all standard treatments, differing only in their urgency. For instance, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) serves as an adaptive method. Since the Jin and Yuan dynasties, practitioners often adhered to variations while neglecting the constants, and focused on adaptive methods at the expense of standard treatments, leading to confused and chaotic discussions. This compilation retains certain divergent statements that could not be omitted, relying on the reader to appreciate the valuable insights while disregarding flaws.
[Nomenclature] Shan refers to abdominal pain. (*Shuowen Jiezi*)
Heart pain is called Shan. "Shan" implies "Shen," referring to Qi rushing upward causing pain. Swelling of the yin organs is referred to as [character missing], indicating Qi sinking downward; it is also called Shan, again implying "Shen," describing the sensation of Qi pulling the lower abdomen with urgent pain. (*Shiming*)
Shan is a Qi disorder in the abdomen characterized by pulling pain up and down. (*Jijiu Zhang*, commentary by Yan Shigu)
[Etiology: Yin Cold] Various forms of Shan result from the accumulation of Yin Qi internally, compounded by external cold invasion, leading to disharmony of Ying and Wei (Nutritive and Defensive Qi), and deficiency of Blood and Qi. Consequently, wind-cold enters the abdomen, forming Shan.
Han Shan (Cold Hernia/Colic) occurs when Yin Qi accumulates internally, obstructing the movement of Wei Qi. When Wei Qi fails to circulate, cold becomes excessive. This manifests as aversion to cold, loss of appetite, coldness of the hands and feet, periumbilical pain, spontaneous sweating, and exacerbation upon exposure to cold, hence the term Han Shan. Shan denotes pain. This arises because Yin Qi accumulates internally, causing cold Qi to knot and bind without dissipating. Due to the weakness of the Fu and Zang organs, wind-cold pathogenic factors clash with healthy Qi, resulting in abdominal pain and internal tension, thus termed Han Shan Abdominal Pain. Heart pain caused by Han Shan stems from the accumulation and knotting of Yin Qi. If Yin Qi does not dissipate, cold becomes excessive; excessive cold causes pain to shift unpredictably. When cold Qi rushes upward to the heart, it causes heart pain. (*Zhubing Yuanhou Lun*)
Shan is caused by the accumulation and knotting of cold Qi. (*Suwen Cizhu*)
[Etiology: Kidney Deficiency] The Kidneys govern the reception of Qi, serving as the Sea of Qi for the human body. When Kidney deficiency allows Wind-Cold to invade, Summer-Heat-Dampness to attack, or emotional disturbances (Joy, Anger, Worry, Fear) to injure, water metabolism stagnates and knots. Combined with Qi conflict, various pathogens gather therein, manifesting as Shan, Ben Tun (Running Piglet), Xiao Chang Qi (Small Intestine Qi), or Pang Guang Qi (Bladder Qi). These are essentially the same entity. (*Zhizhi Fang*) (See also *Yixue Guan Jian* below.)
[Discussion on Liver Involvement and Rejection of Damp-Heat Theory] All Shan diseases belong to the Foot Jueyin Liver Meridian. However, mediocre practitioners incorrectly attribute them to the Small Intestine and Bladder. The Bladder is the Water Palace, responsible for seepage and excretion; the Small Intestine is the Water Channel, responsible for flow. The Kidney (Shaoyin) oversees both water systems. Urine travels from the Stomach to the Small Intestine, then permeates into the Bladder. The Bladder, or Paonang (Urinary Bladder Sac), allows water to exit through the urethra via Qi transformation; this is the normal pathway. When Shan occurs, it belongs to the Foot Jueyin Liver Meridian, which circles the genitalia and enters the lower abdomen. The Liver and Kidneys reside in the lower jiao, connecting with the Chong, Ren, and Du meridians. Although the *Lingshu Jing* mentions that diseases of the Foot Jueyin Liver Meridian include enuresis, strangury, and Hu Shan (Fox Hernia), and treats the Kidney, Bladder, and Small Intestine meridians without explicitly mentioning Shan, the site of Shan pathology is indeed part of the Liver's domain. (The original text cites *Suwen*, *Lingshu*, and *Tongren* extensively regarding the Liver's role in Shan, omitted here for brevity.) Furthermore, enuresis, strangury, impotence, bladder numbness, spermatorrhea, and leukorrhea are men's Shan diseases and should not be wrongly attributed to Kidney Cold. Women suffering from blood depletion and amenorrhea, heat in the waist and knees after menstruation ceases, dryness of the legs and throat, strangury, masses in the lower abdomen (fixed or migrating), protrusion of the anterior yin, and hemorrhoids at the posterior yin are women's Shan diseases, though termed Zha (Masses) rather than Shan. If contracted in youth, infertility results in both sexes. Thus, these matters are unrelated to the Bladder, Kidney, or Small Intestine, but fall under the jurisdiction of the Foot Jueyin Liver Meridian. It is perplexing that common prescriptions discuss only the Bladder, Kidney, and Small Intestine, omitting any mention of Liver Wood, thereby confusing people greatly. (*Rumen Shiqin*)
All Shan diseases originate from the Liver. The Ren Mai (Conception Vessel) is the Sea of Yin Meridians and runs parallel to the Foot Jueyin Liver Meridian within the abdomen. The pulses of Zang organ Shan are described as Boji (tense/rapid) or Hua (slippery). Boji indicates Liver pulse; Hua indicates Wind disease. Since Wind communicates with the Liver, even if Shan affects the Ren Mai and various Zang organs, it invariably connects with the Liver Meridian. Only conditions presenting as solid masses like melons, sounding like frogs, moving up to the abdomen or down to the scrotum, can be truly called Shan diseases. Those unrelated to the Liver cannot be classified as Shan. Regarding etiology, some attribute Shan to Cold, others to Damp-Heat, and some to Fire transforming from Cold. Ultimately, Shan involves Cold, Damp, and Heat pathogens. Cold causes contraction/tightness; Heat causes flaccidity; Dampness causes swelling. Cold is paramount. Cases with Heat involve Cold pathogen suppressing Heat internally; Heat itself does not cause Shan, nor does it transform into Cold. Therefore, "Heat suppressed by Cold" is valid, but "Heat transforming from Cold" is incorrect. (*Jinkui Yi*) (Note: This synthesizes views from Zhang Zihe and *Gezhi Yulun*, slightly edited. *Yitong* states broadly that Cold, Damp, and Heat pathogens cover the Three Causes, but this view is too simplistic and is not recorded.)
Medical classics generally regard Shan as a Cold-Damp syndrome. Danxi alone argued it results from internal stagnant Heat, claiming that without internal Heat, external Cold-Damp would not cause Shan. His argument was eloquent but fundamentally flawed. This condition mostly arises from internal deficiency of the Kidney's Primordial Essence (Yuan Jing). Internal deficiency allows Cold-Damp to enter, causing stagnation and obstructing True Qi, leading to painful conflict. If Yuan Jing is sufficient, Cold-Damp cannot invade, and no pain occurs. This explains the root and branch of Shan, rendering the presence or absence of stagnant Heat irrelevant. Danxi's theory is erroneous. Most physicians consider Shan a Kidney disease or Xiao Chang Qi (Small Intestine Qi, related to the Heart). Zhang Zihe, relying on the *Lingshu Jing*, asserted Shan is a Liver Meridian disease unrelated to the Kidney. I argue Shan stems from internal Kidney deficiency, which seems to repeat the errors of common physicians. Response: Zihe's theory is profound, yet common physicians are not entirely wrong. The Hand Jueyin Mingmen and Foot Jueyin Liver Meridian jointly govern Yuan Jing, functioning through the Kidney's posterior orifice. Ancient texts call the right Kidney the Mingmen, actually referring to the posterior orifice/function, not the anatomical right Kidney. Excessive sexual activity depletes Yuan Jing, allowing pathogens to invade and cause Shan, characterized by pulling pain between the lower abdomen and testicles. Zihe attributes Yuan Jing and sinews to the Liver, thus labeling Shan as a Liver disease, failing to recognize that Yuan Jing deficiency stems from Kidney depletion. Although sinews belong to the Liver, the Kidney is the gathering point of sinews (Zongjin), and the lower abdomen belongs to the Kidney region. Physicians traditionally calling Shan a Kidney disease have valid observations. Naming it Xiao Chang Qi is merely due to its lower location. Treatment requires the method of "using hot remedies for cold conditions" combined with agents that resolve knotting. (*Yixue Guan Jian*)
Shan Qi disease has both Cold and Heat syndromes. However, it invariably begins with Cold-Damp exposure or consumption of raw/cold foods, causing pathogens to gather in the Yin divisions. This initial stage is always due to Cold-Damp. Prolonged stagnation may generate Heat, or in individuals with Yang constitutions, Fire may accumulate with Damp-Heat. Thus, the *Neijing* discusses both Cold and Heat in Shan. Examples of Cold: Abdominal pain with inability to urinate or defecate named Shan, caused by Cold; Yin excess causing pulse distension and obstruction, termed Long Shan; Gan Bi caused by Cold-Damp treated similarly to Shan; Win-Reversal of Taiyang, Taiyin, and Yangming causing Shan Qi. These describe Cold Shan. Examples of Heat: Pi Feng transmitting to Kidney, named Shan Zha, causing冤热 (oppressive heat) and pain in the lower abdomen with white discharge, also called Gu; Foot Jueyin tendon disease causing genital dysfunction, where Cold causes retraction and Heat causes flaccidity/protrusion. These describe Heat Shan. The *Neijing* balances Cold and Heat discussions. Danxi stated that since the *Suwen*, Shan has been viewed as Cold because Cold causes contraction and obstruction, leading to pain. Yet some who wade in ice/water never suffer from this due to lack of internal Heat. Generally, this disease starts with Damp-Heat in the meridians, stagnating over time, compounded by external Cold binding, preventing dispersion, thus causing pain. Treating it solely as Cold is insufficient. (*Gezhi Yulun*) Given Danxi's focus on Fire, he heavily used Gardenia (Zhizi) and Phellodendron (Huangbai). I must comment. As seen in the *Neijing*, Shan is not exclusively Cold; Cold is mentioned more frequently, which is correct. How can one contract Shan without initial Cold? Cold is the root; Heat is the branch. Claiming Damp-Heat is the root and Cold the branch is illogical. Those who wade in ice without illness do so because their internal Yang is strong enough to repel Cold. Claiming they lack internal Heat to prevent Cold invasion is incorrect. The etiology requires clarification. We must follow the precise *Neijing* theories and not blindly trust later, biased interpretations. (*Jingyue Quanshu*)
[Diverse Etiologies] Treatment must investigate the cause. While often caused by Cold-Damp, it can arise from sexual excess, overwork, anger/stress, or dietary indiscretion (alcohol/damp-foods) leading to Cold invasion. Yin seeking Yin leads to knotting in the Chong and Ren seas, descending to the Yin division, forming various Shans. Manifestations vary: triggered by Cold, Heat, Stress (Qi rebellion), Dampness, Fatigue (sinew injury), Sexual activity (deficient pathogens in Shaoyin/Jueyin), or Alcohol/Dairy (Dampness in Yangming/Taiyin). Chronic cases involve sinking of Healthy Qi and retention of Pathogenic Qi, becoming difficult to cure. Treatment must address the specific cause. Ignoring this leads to failure. (*Jingyue Quanshu*)
[Pulse Diagnosis] In the Cun Kou area... internal knotting indicates Shan Zha. Fine, small, and urgent pulses indicate rapid progression; central firmness indicates Chong Mai involvement, associated with Cold Shan Zha accumulations and stabbing abdominal pain. (*Maijing*)
Both Chi and Cun pulses are Firm (or Empty), rising and falling straight—this is Chong Mai, indicating Cold Shan in the chest. Central firm pulse reaching the Guan position indicates Chong Mai, causing lower abdominal pain, Qi rushing to the heart, Zha/Shan, sterility, incontinence, and flank fullness/agitation. (*Maijing*)
For women with Shan Zha accumulations, String-taut and Urgent pulses indicate survival; Weak and Small pulses indicate death. (*Maijing*)
Deep, fine, and Slippery pulses indicate Shan Zha. Urgent and Slippery pulses indicate Shan Zha. (*Zhubing Yuanhou Lun*)
Shan Qi involves Qi accumulation and expansion, yet externally constrained. Pulses appear String-taut and Urgent; symptoms are distension and pain. String-taut/Urgent/Direct pulses indicate Qi stagnation, governing Shan distension. All Shan involves pain/distension. If String-taut/Urgent and Firm, indicating rooted accumulation, it reflects robust constitution; Pulse and Syndrome match, indicating survival. If merely Urgent and Weak, Urgency means Excess Pathogen, Weakness means Deficient Healthy Qi; unsuitable for internal accumulation, indicating death. (*Xuyan*) (Note: Danxi describes deficient cases with Deep, Tight, Wide, and Forceless pulses, see below.)
[Treatment Discussions] Shan denotes pain. Symptoms include lower abdominal pain with urinary/fecal retention; cold limbs, periumbilical pain, sweating; cold Qi rushing to heart/abdomen causing heart pain; internal tension and abdominal pain. These varied symptoms constitute "Various Shans." (*Zhubing Yuanhou Lun*)
Shan varies by Zang/Fu deficiency/excess and external pathogen interaction. Cold congeals, Wind scatters, Summer-Heat stagnates, Dampness adheres, causing twisting/stabbing pain without fixed location, unbearable in acute phases. Terms like Hengxian, Shuxian, Bladder/Xiao Chang Qi, and Zeifeng Rudu refer to different names but identical symptoms. Treatments: Warm for Cold, Disperse for Wind, Drain for Summer-Heat, Dry for Damp. Each has established methods. (*Sanyin Fang*)
Symptoms extend beyond external genitalia and lower abdomen to waist/flank stabbing, back migration, cold Qi to heart, periumbilical pain, cup-like flank masses, arm-like umbilical masses, peach/plum-like abdominal lumps, plate-like epigastric masses, high fever/aversion to cold, chills, urinary/fecal retention, tenesmus/diarrhea, sweating, anorexia. Genital symptoms include variable testicle size/movement, scrotal swelling/pain, mass migration to scrotal root or abdomen upon anger/cold, returning spontaneously upon calmness. These are collectively called Shen Qi. General principles: Disperse Wind, Warm Cold, Resolve Summer-Heat, Leech Damp, Regulate Heart Qi for Emotional causes, Promote Urination for Water-Qi conflict. Use Shen Qi formulas as adjuncts. The core strategy is promoting circulation and unblocking; do not fear unblocking due to Kidney deficiency. If pathogens block the Kidney, they must be expelled. Indulgence or fear of deficiency leading to constipation and pathogenic rush to the heart is dangerous. Differentiate Cold vs. Heat within deficiency. Cold: Clear flanks/genitals, frequent urination, triggered by cold. Heat: Summer-Heat/Dampness/Acquired Heat from warm herbs, hot genitals/intestines, frequent/scanty urination, worsened by heat. Mixed Cold/Heat: Alternating cold/heat in lower abdomen/genitals, irregular bowel/bladder function. Adjust warming/cooling drugs accordingly, maintaining circulation. After bowel/bladder clearance, if dragging pain or Qi wandering in skin remains, add nourishing herbs (Ren Shen, Dang Gui, Chuan Xiong, Bai Shao, Sang Piao Xiao, Hu Lu Ba) for Kidney/Blood deficiency and Qi return. (*Zhizhi Fang*)
Severe Shan Qi causes urgent pain in testicles and lower abdomen. Pain may be in testicles or near Wushu (GB29) acupoint, both Foot Jueyin pathways. Masses may be visible/audible (like melons/frogs). Deficient cases require Ginseng and Atractylodes with unblocking agents; pulses are deeply tight yet wide/forceless, pain is mild with heavy dragging sensation. (*Gezhi Yulun*) (Note: *Bencao Gangmu* lists unblocking agents like Tao Ren, Shan Zha, Zhi Shi, etc., adjunct to Ren Shen/Atractylodes. *Huibu* suggests adding Gui Zhi/Fu Zi to Ren Shen/Atractylodes for deep/tight pulses, warning against harsh purgatives which can cause gastric attack and death.)
Pressing painful areas: Severe pain upon pressure indicates Excess; indeterminate/non-specific pain indicates Deficiency. (*Danxi Xinfa*) (Synthesized from *Gangmu* and *Xinfa*)
Qi knotting due to Cold forms Shan; Blood knotting due to Cold forms Zha. Current terms: Hengxian, Shuxian, periumbilical radiating pain, lower abdominal pain. Use Pancong San, swallow Zhuyu Neixiao Wan, or Yi Gong San adjusted with salt/wine. Shengliao Wuling San with added [missing herb] powder (0.5-1 qian) works for all types. If ineffective, severe stabbing pain, penile retraction, cold limbs: Apply Fried Fuzi with salt wrapped in silk to warm the umbilicus. If bowels/bladder blocked: Wuling San plus Gui Zhi, followed by Qingmuxiang Wan. Initial onset with headache/fever or aversion to cold/high fever: Rensu Yin plus Mu Xiang. Qi rushing to heart causing heart pain without lower abdominal pain: Fresh Chinese Chive juice mixed with Wuling San pills, taken with [missing herb] ginger soup. (*Yaojue*) (Note: *Yijian Fang* cites Dai's basis for Rensu Yin in initial Shan Qi with chills/fever/vomiting.)
Initial onset with headache/fever, aversion to cold/high fever, severe cases with Qi rushing to heart, pain/vomiting, cold limbs, deep/urgent pulse. First dispel Cold with agents that soothe Liver and resolve Shan, subduing pathogenic Qi. Using Zihe's purgative methods risks depleting Healthy Qi before curing the disease, leading to collapse. Students should ponder this. (*Yitong*)
Han Shan causes severe pain, often from Cold exposure or raw/cold food. Signs: preference for warmth, aversion to cold, String-taut/Fine pulse, cold nose/hands/feet, no heat in excretions. Re Shan (Heat Hernia) causes severe pain from Fire accumulating in Yin divisions. Signs: Heat syndrome/pulse, constipation, hot/obstructed urination, distension/fullness, irritability, preference for cold. If Kidney is not deficient but Liver Meridian has Damp-Heat/Fire, pain in the penis, tendon contraction, itching/swelling, flaccidity/protrusion, white discharge with urine: This is Jin Shan (Sinew Hernia), treat with Longdan Xiegan Tang. Shi Shan (Damp Hernia) causes heaviness/distension, sometimes pain; treat referencing Cold/Heat patterns. Painless chronic prolapse is Tui Shan (Prolapse Hernia), treat Damp and regulate Qi. Wine-triggered Shan is usually Damp-Heat; resolve Damp first. Blood stasis in lower abdomen is Xue Shan (Blood Hernia); check for non-Qi/non-Food causes, hard lower abdominal mass, black constipation, clear urination. Sex-triggered Shan indicates Yin Deficiency. Chronic Shan often involves Deficiency, or original Qi deficiency with occasional attacks... (Text ends)